Use of aminoquinolines as a prophylactic agent against COVID‑19 in frontline workers : a critical review

Abstract

Emerging and reemerging pathogens are global challenges for public health. The infectious disease COVID‑19 caused by SARS- CoV-2, a newly emerged beta coronavirus is spreading throughout the globe. There is currently no specific treatment nor a vaccine available for the disease, though the pandemic continues to grow, the scientific community is searching eagerly to employ a prophylactic drug that could decrease COVID‑19 spread. As chemoprophylaxis is an acceptable approach in mitigating infectious diseases, discovering an efficient chemoprophylactic agent could be one way to potentially control COVID‑19. There have been several existing drugs repurposing for the treatment and prevention of COVID‑19. Most research efforts are focused on the 4-aminoquinoline derivative compounds hydroxychloroquine (HCQ) and chloroquine (CQ). A literature search was performed using Google Scholar and PUBMED to find articles about the role of CQ/HCQ as a prophylaxis to COVID‑19. In addition, a review of all the clinical trials registered in clinical trials.gov focusing on HCQ and its role as prophylaxis for COVID‑19 in frontline workers is also included in this review. A total of 59 publications are included, of these 24 are ongoing clinical trials, and 35 publications including pre-clinical and clinical studies as well as systematic reviews, research letters/ correspondence, opinions, and viewpoints have been included, in the intention to outline the current evidence regarding the benefits and harms of using HCQ/CQ as a prophylactic for COVID‑19 in frontline workers, in addition, to provide an overall picture of the use of these drugs around the world, for this purpose. In conclusion, the literature does not yet present well-designed clinical studies that demonstrate HCQ/COQ effectiveness in COVID‑19, However, we are in a race against time to find effective treatments and preventive measures against the growing pandemic, considering the repositioning drugs like 4-aminoquinoline derivatives CQ and HCQ, that shows antiviral efficacy against SARS-CoV-2 , which are easily available, affordable, and have a good safety profile, in a resource-poor country, like the Maldives, will benefit the healthcare system and augment the safety of frontline workers against COVID‑19.